Multiple Sclerosis Eye Complications

By Karen Appold | Medically reviewed by Niya Jones, MD, MPH

The majority of MS patients will experience vision problems throughout the course of their lives. Though serious complications are rare, it's important to discuss possible treatment options with your doctor to quickly and effectively treat the affliction.

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Vision problems are often the first symptom of multiple sclerosis, indicating issues within the optic nerve.

More than 80 percent of multiple sclerosis (MS) patients will experience eye complications related to the condition – an autoimmune disease that targets
the brain and central nervous system. Complications include nystagmus, diplopia, internuclear ophthalmoplegia and optic neuritis.

Complete vision loss is rare but still a possibility. Talk to your doctor about these conditions and discuss their associated risks. Oftentimes, prescribed
medications can lessen the likelihood of severe problems and blindness.

Eye Problems: MS Nystagmus

Nystagmus is the most common of all the eye complications related to multiple sclerosis, affecting more than a third of those with the disease.
When an MS attack targets the brainstem or cerebellum, which control eye movements, patients may experience blurred vision, oscillopsia (a sense that something stationary is moving), and vertigo (a spinning sensation).

Nystagmus usually lasts for about six to eight weeks. But for people with progressive forms of MS, nystagmus may be persistent and lifelong. Your eye
doctor can prescribe medications or glasses containing prisms that shift the eyes to lessen symptoms. If the condition is severe, nystagmus can be treated
by paralyzing the eye muscles with botulinum toxin injections or eye muscle surgery.

Eye Problems: MS Diplopia

Diplopia, better known as double vision, surfaces when an MS attack affects the brainstem or cerebellum. Symptoms include seeing a single image out of
each eye, but double when looking out of both eyes together. The doubling may be side-to-side, up-and-down, or a combination of the two and can vary
depending on the visual task, such as reading versus looking at something far away.

The conditionmost often clears up in six to eight weeks, but in some cases, can persist indefinitely. Treatment options include eye patches and
special eyeglasses that line up the conflicting images. Long-term patients may choose to undergo an strabismus eye muscle surgery, which can straighten the
eyes.

Eye Problems: MS Internuclear Ophthalmoplegia

In young, otherwise healthy people, internuclear ophthalmoplegia almost always indicates MS, and nearly a quarter of all MS patients will experience this
condition. In older people, internuclear ophthalmoplegias are more commonly caused by strokes, not MS.

Symptoms of internuclear ophthalmoplegia (IO) include blurred vision, double vision, dizziness, and a sense of movement when looking at something
stationary. The complication is caused by an inflammation in the brainstem, which helps control eye movements.

Caused by an inflammatory neuromuscular condition called myasthenia gravis, IO almost always disappears over the course of several weeks. Occasionally,
these symptoms will persist for longer after an MS relapse or in a person with a progressive form of MS. Doctors may elect to treat the symptoms.

Eye Problems: MS Optic Neuritis

Optic neuritis is caused by inflammation in either one or both optic nerves, which connect the eyeball to the brain. Symptoms include blurred vision,
impaired color vision, peripheral vision loss, and eye pain. At least 85 percent those with optic neuritis regain normal or near normal vision after
about six to eight weeks. The remaining 15 percent can experience moderately blurred or hazy vision in the affected eye, and occasionally, patients
lose their vision permanently.

There are no cures for optic neuritis. Intravenous steroids may speed recovery but won’t improve the ultimate visual outcome. Extra lighting at home and work, and vision aids such as
magnifiers or special spectacle and computer screen filters, can help compensate for any perception loss.

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